The number of children with obesity in developed countries is constantly increasing; in Spain there are already more than a million obese children. This health problem has become the main priority for the Spanish Ministry of Health and Consume, and with this program we pursuit to educate the school community in healthful nutritional habits, integrating the cultural diversity of the schools.
Today's society is characterised by increasingly less healthy lifestyles and customs.1-3 Paradoxically, this changing behaviour has been accompanied by an overall increase in health programmes; a two-faceted reality that must not be ignored.
Two key factors normally play
an important role in the majority of health problems: diet and physical exercise.
Our research focuses on nutrition education; an issue that is of growing concern
to policymakers4 and society as a whole due to the progressive rise
in childhood obesity. Indeed, Spain has the second highest number of obese youngsters
in Europe.5 Given that educational programmes targeted at fomenting
healthy eating habits must also take account of the cultural diversity6
that exists in schools today; our research has also addressed this new social
reality. Therefore our ultimate aim is to provide the educational community
with the necessary knowledge and understanding to make informed choices about
what they eat, while bearing in mind the cultural diversity of society today.
Using information gathered from an earlier research project, we have designed a school health programme to promote good eating habits. That study, in which qualitative and quantitative instruments7,8 were used, pursued three major objectives: i) determine beliefs and educational needs among the school body regarding nutrition and eating habits; ii) analyse nutrition education in schools; and iii) identify the eating habits of students from other cultures within the school setting itself, particularly in school dining rooms. The aim was to develop an educational project that takes account of the ethnic diversity enriching our schools today.
The subjects for the study were
selected from among 29 public schools located in the city of Huelva and its
outlying urban area due to their accessibility and the fact that public schools
have the largest immigrant student body. The study focussed on the pre-school
level and grades 1-3 of primary school9 given that nutritional requirements
play a very important role at this stage of development; a time when the building
bricks for nutrition-related values10 and respect for cultural differences are
laid down. Moreover, we only selected schools with a dining room as this setting
was of utmost importance to our analysis of students' eating habits and the
social interaction between them.
The results of our previous research study have served as a cornerstone for designing our proposal for educational intervention. The results of that study demonstrated that a global and integrated educational programme to foment healthy eating habits from the standpoint of cultural diversity is lacking in the schools studied. In what follows, we discuss the last phase of this research study which consists in the design of an educational project whose final aim is to raise awareness and educate the school community11,12 about the importance of encouraging healthy eating habits in early childhood, while attending to cultural diversity.
Although the City Council of Huelva and the Ministry of Health and Education13,14 of the Regional Government of Andalusia have designed and developed teaching materials targeted at promoting healthy eating habits, the aim of our programme is not to produce similar materials, but to make use of these resources to complement the educational intervention programme presented here. Our programme has been designed as a joint initiative requiring the support of the administration and on-going cooperation between the different institutions involved (City Hall, Provincial Department of Health and Provincial Department of Education). Furthermore, the project includes the development of an educational programme to be broadcast on television.15
The positive effects and scope of a media such as local television will encourage collaboration between all the spheres involved, in addition to improving the credibility of television and enhancing channels for participation given that the audience will be comprised of the stakeholders themselves. Moreover, by broadcasting our programme on television we will be able to reach out to all citizens alike with relatively little effort. A programme of this kind will permit citizens not only to become informed about this issue, but aid them in making healthy food choices; a fact that will no doubt have a positive impact on their overall state of health.
The efficacy of educational programmes on television has been widely demonstrated. While several programmes currently deal with health and healthcare in general, none are targeted specifically at healthy eating habits among children and cultural diversity; a fact has led us to disseminate our educational discourse with the aid of television.
Each of the three public institutions involved in the programme will appoint a person to be in charge of the project in their particular institution. Those appointed should be professionals who are already taking part in nutrition education programmes in schools due to their knowledge, interest and experience in this area. The institutions will also appoint one general coordinator who will be responsible for overseeing the television programme as well as supervising the three professionals appointed by each of the institutions. The project will be specifically aimed at promoting healthy eating habits among children and the educational community of the province of Huelva. An overview of the work plan and the project are presented in Figure 1 below.
The three institutions will participate in the project as follows. A social worker and social educator from the City Hall of Huelva will be in charge of cases of child malnutrition16 since it makes little sense to speak of a balanced and varied diet when malnutrition remains a problem. A medical nutritionist who forms part of the Educational Guidance Team (EGT; EOE in Spanish) of the Provincial Department of Education will be responsible for training teachers (diet and nutrition, integrating healthy eating habits in the educational programmes of schools and in the classroom, etc,) and monitoring and providing consultancy services to school dining rooms (balanced and varied menus, educating students about healthy eating habits,17 training the monitors that work in the dining rooms, etc.). Moreover, the City Hall, the Provincial Department of Education and the Provincial Department of Health will jointly appoint a coordinator who will be responsible for the marketing campaign, supervising the television programme and enrolling schools in the educational programme. At the beginning of each academic year, any schools that wish to enrol in the programme may do so. Each school will be required to design and develop a pilot experience dedicated to healthy eating from an intercultural perspective, which will be taped and broadcast on the local television station. The programme content will vary to allow each school to tailor the pilot experience to the needs of its student body.
One of the most outstanding aspects of the project is the marketing campaign18 to disseminate and promote our educational project. The aim of this campaign is to reach out to all of the educational community. To achieve this aim, the coordinator in charge of the campaign will use a wide range of resources including the actions described in Figure II below.
The campaign coordinator will maintain on-going contact with each of the professionals involved in the project and in the television programme from the following institutions of the province of Huelva: the City Hall of Huelva, the Provincial Department of Education, the Provincial Department of Health, the Huelva Acoge Association and the Red Cross (both of which attend to immigrants in the province) as well as healthcare centres, schools and the local television station. Marketing activities will include the preparation and distribution of nutrition guides. The schools will be given a sufficient number of copies of the guide for distribution to both families and teachers as it would make no sense for teachers to transmit information to their students that the families are unknowledgeable about and cannot share with their children. The rest of the actions will be carried out in each of the sectors shown in the above scheme. One of these actions will entail posting promotional posters such as the one shown in Figure III.
Another marketing action will consist of producing an advertisement to be broadcast on the local TV station with the collaboration of a local celebrity such as a child or young singer.
In addition to these marketing actions, the general coordinator, the social worker, the social educator and the medical nutritionist will be provided with a project identification card to ensure that contact with members of the educational community is sustained on a regular basis.
It is essential that the programme be tailored to the language and capacities of young students. The programme must also encompass an intercultural perspective in order to reach out to the diverse cultures that make up our population.
The television programme will serve as a stage to underline the involvement of the above institutions. Through this multidisciplinary approach, it will become clear to all those involved that this is not simply a programme that has been created in an office somewhere and left on the desk of the school director to ensure that the teachers put it in motion. Moreover, it will permit families to resolve doubts or problems that have often been left unanswered. It will also reach out to all the members of the community to motivate and encourage them to reflect upon their diet and nutritional habits.19
The television programme will have a duration of approximately 30 minutes and be broadcast one day a week; preferably on Saturdays to allow the whole family to view the programme. The programme will be broadcast during children's viewing time, specifically from 12:00-12:30 pm just before lunchtime with a view to reinforcing their knowledge of good dietary habits. Fifteen episodes will be taped during each academic year, which may be increased or reduced in amount depending on the number of pilot experiences conducted by each school. The three sessions comprising each episode of the television programme are described in Figure IV.
The first session will consist of a chat-discussion with a paediatrician, a midwife and the medical nutritionist taking part in the project. The audience will be able to consult these health professionals, who will discuss a different topic each day. A different paediatrician and midwife will participate in each episode to allow practitioners from all of the healthcare centres to collaborate. In this way, viewers will be able to see and listen to their own paediatricians and midwives.
The second session will consist of a taped educational experience led by a teacher or a guided visit. Visits will be made to centres and facilities that produce or sell foodstuffs as well as farms, stockbreeders and fisheries located in the province of Huelva.
Finally, the third session will consist of a cooking workshop. The workshop will be held in the kitchens of the schools taking part in the programme. The schools will participate on an alternating basis to allow all the school dining rooms to be taped and viewers to see the environment in which school children normally have lunch. In this session, parents or teachers accompanied by their students may participate. Particular emphasis will be placed on Andalusian cuisine to disseminate the Mediterranean diet as well as on the culinary customs of the diverse cultures found in the school. When the parents of other cultures explain the traditional dishes of their own country, viewers will have the opportunity to learn about other types of foods, which will be provided by the coordinator in charge.
The nutritionist will be present during the workshop to explain, among other aspects, the nutritional characteristics of the dish of the day to ensure that the information and cooking methods are suitable for the audience, that is, parents and students. By structuring the session in this way, we aim to transmit integral messages: knowledge about cooking techniques and food preservation methods as well as how to handle foods properly and analyse their nutritional components. Therefore, teachers and students, as well as parents, may participate in the second and third sessions.
We are aware that in order to change eating habits and ensure that these changes are maintained, our project must be extended over time. Therefore, the on-going evaluation of all spheres of action will be necessary if we are to achieve a positive outcome and ensure that the project is sustained on a regular basis.20
and points discussed here are, in our judgement, basic and crucial. However,
we are also aware that the scope of a project of this kind adds to its complexity.
For that reason, before garnering the support and collaboration of institutions
in the project, we will conduct a pilot experience that should serve to set
the direction of the definitive project.
project aims to attend to the needs detected in the schools that collaborated
in the study. Although this project is the outcome of a research study undertaken
in the province of Huelva, its broad and global scope will permit it to be implemented
at a variety of levels, be they local, provincial or regional. Furthermore,
the continual assessment and revision of the project from the time it is implemented
at the local level, will permit us to ascend to higher levels such as the regional
or even the state level.
1. Consejería de Salud.
Escuela Andaluza de Salud Pública. Instituto de Nutrición y Tecnología
de Alimentos. Valoración del estado nutricional de la Comunidad Autónoma
de Andalucía. Sevilla: Consejería de Salud; 1999.
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